Nuclear cardiology practice and associated radiation doses in Europe : results of the IAEA Nuclear Cardiology Protocols Study (INCAPS) for the 27 European countries
Lindner, Oliver (Institute of Radiology, Nuclear Medicine and Molecular Imaging, Heart and Diabetes Center North Rhine-Westphalia Bochum, University Hospital of the Ruhr University, Germany)
Pascual, Thomas N. B. (Section of Nuclear Medicine and Diagnostic Imaging, Division of Human Health, International Atomic Energy Agency, Vienna, Austria)
Mercuri, Mathew (Division of Cardiology, Department of Medicine, Columbia University Medical Center and New York-Presbyterian Hospital, New York, NY USA)
Acampa, Wanda (Institute of Biostructures and Bioimaging, National Council of Research, Naples, Italy)
Burchert, Wolfgang (Institute of Radiology, Nuclear Medicine and Molecular Imaging, Heart and Diabetes Center North Rhine-Westphalia Bochum, University Hospital of the Ruhr University, Germany)
Flotats, Albert (Institut d'Investigació Biomèdica Sant Pau)
Kaufmann, Philipp A. (University Hospital Zurich (Suïssa))
Kitsiou, Anastasia (Department of Cardiology, Sismanoglio Hospital, Athens, Greece)
Knuuti, Juhani (Turku PET Centre, University of Turku, and Turku University Hospital, Turku, Finland)
Underwood, S. Richard (Royal Brompton Hospital (Londres))
Vitola, João V. (Quanta Diagnóstico & Terapia, Curitiba, Brazil)
Mahmarian, John J. (Department of Cardiology, Houston Methodist DeBakey Heart and Vascular Center, Houston, TX USA)
Karthikeyan, Ganesan (All India Institute of Medical Sciences (Nova Delhi, Índia))
Better, Nathan (Royal Melbourne Hospital (Melbourne, Austràlia))
Rehani, Madan M. (Harvard Medical School)
Kashyap, Ravi (Section of Nuclear Medicine and Diagnostic Imaging, Division of Human Health, International Atomic Energy Agency, Vienna, Austria)
Dondi, Maurizio (Section of Nuclear Medicine and Diagnostic Imaging, Division of Human Health, International Atomic Energy Agency, Vienna, Austria)
Paez, Diana (Section of Nuclear Medicine and Diagnostic Imaging, Division of Human Health, International Atomic Energy Agency, Vienna, Austria)
Einstein, Andrew J. (Department of Radiology, Columbia University Medical Center and New York-Presbyterian Hospital, New York, NY USA)
Universitat Autònoma de Barcelona

Date:	2015
Abstract:	Nuclear cardiology is widely used to diagnose coronary artery disease and to guide patient management, but data on current practices, radiation dose-related best practices, and radiation doses are scarce. To address these issues, the IAEA conducted a worldwide study of nuclear cardiology practice. We present the European subanalysis. In March 2013, the IAEA invited laboratories across the world to document all SPECT and PET studies performed in one week. The data included age, gender, weight, radiopharmaceuticals, injected activities, camera type, positioning, hardware and software. Radiation effective dose was calculated for each patient. A quality score was defined for each laboratory as the number followed of eight predefined best practices with a bearing on radiation exposure (range of quality score 0 - 8). The participating European countries were assigned to regions (North, East, South, and West). Comparisons were performed between the four European regions and between Europe and the rest-of-the-world (RoW). Data on 2,381 European patients undergoing nuclear cardiology procedures in 102 laboratories in 27 countries were collected. A cardiac SPECT study was performed in 97. 9 % of the patients, and a PET study in 2. 1 %. The average effective dose of SPECT was 8. 0 ± 3. 4 mSv (RoW 11. 4 ± 4. 3 mSv; P < 0. 001) and of PET was 2. 6 ± 1. 5 mSv (RoW 3. 8 ± 2. 5 mSv; P < 0. 001). The mean effective doses of SPECT and PET differed between European regions (P < 0. 001 and P = 0. 002, respectively). The mean quality score was 6. 2 ± 1. 2, which was higher than the RoW score (5. 0 ± 1. 1; P < 0. 001). Adherence to best practices did not differ significantly among the European regions (range 6 to 6. 4; P = 0. 73). Of the best practices, stress-only imaging and weight-adjusted dosing were the least commonly used. In Europe, the mean effective dose from nuclear cardiology is lower and the average quality score is higher than in the RoW. There is regional variation in effective dose in relation to the best practice quality score. A possible reason for the differences between Europe and the RoW could be the safety culture fostered by actions under the Euratom directives and the implementation of diagnostic reference levels. Stress-only imaging and weight-adjusted activity might be targets for optimization of European nuclear cardiology practice.
Rights:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Language:	Anglès
Document:	Article ; recerca ; Versió publicada
Subject:	Nuclear cardiology ; Myocardial perfusion scintigraphy ; SPECT ; PET ; Radiation dose ; Best practices ; Quality of care ; Europe
Published in:	European Journal of Nuclear Medicine and Molecular Imaging, Vol. 43 (december 2015) , p. 718-728, ISSN 1619-7089

DOI: 10.1007/s00259-015-3270-8
PMID: 26686336

11 p, 323.2 KB

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